The present invention relates to a surgical apparatus for retracting a patient's anatomy to provide exposure of an operative site, and more particularly relates to a latch universal cam-operated joint apparatus which is sturdy, readily adjustable, easy to use, conducive to thorough sterilization, and suited for use in conjunction with a tubular frame stretcher or operating room table.
In surgical operations, some type of retraction apparatus is needed to access internal organs and bone structures. Variance in types of surgery and patient size necessitate a device which is both adjustable and sturdy. Furthermore, the nature of a patient's injuries or the patient's condition may make it desirable to perform a surgical procedure while the patient remains on a tubular frame stretcher as opposed to transferring the patient to a conventional operating table. In addition, equipment sterilization requirements necessitate a device which can be thoroughly cleaned by conventional means in a safe and easy manner.
Heretofore, table mounted surgical retraction devices have utilized rail clamps. The first type of rail clamp commonly used may not be secured to an operating table without breaking the sterile field. During surgery, repositioning of this rail clamp must be performed by a non-sterile circulating nurse, thereby increasing the duration of the surgery. An example of such a rail clamp is disclosed in U.S. Pat. No. 4,617,916. Other examples of various rail clamps are described in U.S. Pat. Nos. 4,254,763 and 4,971,038.
In addition, surgical retraction devices utilize universal connecting joint mechanisms. Such joint mechanisms consists of several parts which allow the surgeon to swivel and/or rotate the retractor blades into place. Examples of such devices are disclosed in U.S. Pat. Nos. 3,221,743, 4,617,916, and 5,025,780.
However, moving such retractor blades requires loosening the universal joint, moving the retractor blade and then re-tightening the joint. It would be highly desirable to have a universal joint mechanism which permits quick tightening of the joint and ease of movement of the retractor blade.
Further, during many surgical procedures, most operating rooms utilize table mounted mechanical retractors. This eliminates the need for operating room personnel to hold the retractors during the surgical procedure. The table mounted retractor allows the retractor blades to be mounted to a frame that is mounted to the operating room table. The frame is erected around the operating field and then remains basically static throughout the procedure.
The rigidity of the frame provides a strong, stable platform to mount retractors. However, it is not as versatile as a human counterpart. Also, because the desired exposure is not always directed to the center of the operating site, many times retractors are needed to be positioned to elevate or push down on the margins of the incision. The rigidity of the frame limits the exact placement of the retractor blades especially with ring type retractors as disclosed in Gautier U.S. Pat. No. 3,965,890 and Cabrera U.S. Pat. No. 4,421,108. Another system is disclosed in U.S. Pat. Nos. 3,221,743 and 5,025,780. Also, a retractor disclosed in LeVahn U.S. Pat. Nos. 4,617,916; 4,718,151; 4,947,707; and 5,020,195 as well as a retractor disclosed in U.S. Pat. No. 5,242,240 to Gorham expand the blade positioning capabilities.
These retractors utilize a universal joint to connect the retractor blade to the frame. The universal joint provides the surgeon with greater flexibility in blade placement. The universal joint disclosed in a table mounted retractor in 3,221,743 describes a joint made up of two clamping members, a conical bushing, and a means for providing compressive forces. A similar clamp design is shown in the LeVahn patents mentioned above.
The universal joint is quite strong and versatile, however, if the surgeon wishes to add a retractor blade between two secured components, it is impossible to do so. To make it easier to add retractors between secured components, LeVahn developed a split universal joint shown in U.S. Pat. Nos. 4,617,916, 4,718,151, and 4,917,707 mentioned above. The split universal joint allows retractors to be added to the frame between secured components.
However, because it does not encircle the frame arm, it is not as strong as the standard joints and will slip under pressure. Furthermore, because of the number of components of the split universal joint, it is difficult to sterilize and reassemble.
An inventor of the present application solved the component problems by designing a one-piece universal joint as disclosed in U.S. Pat. No. 5,025,780. To overcome the split joints slipping problem, LeVahn disclosed a hinge clamp in U.S. Pat. No. 5,020,195 which encircles the frame arm giving the joint additional strength. However, a problem with the hinge joint is that it is cumbersome to use, and does not use a bushing so that it can be rotated easily. Also, once it is on the frame arm, it can be difficult to slide and position. In addition to the problems discussed above, all of the above joints incorporate a thread clamping means which requires lubrication and maintenance.